Difference between revisions of "Cystectomy"
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A cystectomy is the removal of all or part of the urinary bladder. Most commonly, this procedure is to address cancer. | A cystectomy is the removal of all or part of the urinary bladder. Most commonly, this procedure is performed to address cancer. | ||
== Preoperative management == | == Preoperative management == | ||
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|- | |- | ||
| | |Pulmonary | ||
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|- | |- | ||
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=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
* 2 PIVs for open, radical, or robotic cystectomy (18g+) | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
* GETA | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ||
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* If radical cystectomy, have T&S and consider T&C 2 units | * If radical cystectomy, have T&S and consider T&C 2 units | ||
* Some centers use indocyanine 25mg to visualize blood flow to the ureters | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
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=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | === Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | ||
* PACU | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ||
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!Open cystectomy | !Open cystectomy | ||
!Minimally invasive cystectomy | !Minimally invasive cystectomy | ||
!Robotic cystectomy | |||
|- | |- | ||
|Unique considerations | |Unique considerations | ||
| | |Involves removal of entire bladder, nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells | ||
| | |Possible when the cancerous lesion is located in the dome of the bladder. Does not require urinary diversion | ||
|Simple, open cystectomy involves removal of the entire bladder without removal of any adjacent structures or organs. Urinary diversion is then created. | |||
| | | | ||
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|- | |- | ||
|Position | |Position | ||
|Supine, sometimes lithotomy for females | |||
|Supine | |||
|Supine, one or both arms out | |||
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| | |Steep Trendelenburg | ||
|- | |- | ||
|Surgical time | |Surgical time | ||
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|~ 4-6 hrs | |||
|- | |- | ||
|EBL | |EBL | ||
|300-1500 | |300-1500 | ||
|Minimal | |Minimal | ||
|1000mL | |||
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| | |100-200mL | ||
|- | |- | ||
|Postoperative disposition | |Postoperative disposition | ||
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| | | | ||
|PACU | |||
|- | |- | ||
|Pain management | |Pain management | ||
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|2 | |||
|- | |- | ||
|Potential complications | |Potential complications | ||
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[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
[[Category:Urology]] | |||
Latest revision as of 16:26, 4 April 2022
Cystectomy
| Anesthesia type |
General / Neuraxial |
|---|---|
| Airway |
ETT |
| Lines and access |
Partial: PIV x 1 (20) |
| Monitors |
Partial: Standard |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative |
hemorrhage, wound infection, DVT, UTI, ureterointestinal leakage, ileus |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A cystectomy is the removal of all or part of the urinary bladder. Most commonly, this procedure is performed to address cancer.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
- If spinal used, ensure T4 sensory level
- Consider using epi in spinal to prolong block
- Can consider placing epidural if significant post-op pain anticipated
Intraoperative management
Monitoring and access
- 2 PIVs for open, radical, or robotic cystectomy (18g+)
Induction and airway management
- GETA
Positioning
- Supine
- Sometimes females placed in lithotomy
Maintenance and surgical considerations
- If radical cystectomy, have T&S and consider T&C 2 units
- Some centers use indocyanine 25mg to visualize blood flow to the ureters
Emergence
Postoperative management
Disposition
- PACU
Pain management
Potential complications
- Bleeding
Procedure variants
| Radical cystectomy | Partial Cystectomy | Open cystectomy | Minimally invasive cystectomy | Robotic cystectomy | |
|---|---|---|---|---|---|
| Unique considerations | Involves removal of entire bladder, nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells | Possible when the cancerous lesion is located in the dome of the bladder. Does not require urinary diversion | Simple, open cystectomy involves removal of the entire bladder without removal of any adjacent structures or organs. Urinary diversion is then created. | ||
| Position | Supine, sometimes lithotomy for females | Supine | Supine, one or both arms out | Steep Trendelenburg | |
| Surgical time | 4-6 hours | ~ 2 hours (urinary diversion not required) | ~ 4-6 hrs | ||
| EBL | 300-1500 | Minimal | 1000mL | 100-200mL | |
| Postoperative disposition | PACU | ||||
| Pain management | 2 | ||||
| Potential complications |